[Epidemiology and burden of rotavirus diarrhea in day care centers in Lyon, France]. / Epidémiologie et impact de la gastroentérite aiguë à rotavirus dans les crèches municipales de la ville de Lyon - saison 2004-2005.

Rotavirus is the main cause of severe, dehydrating diarrhoea in infants and young children. In industrialized countries, pediatric rotavirus gastroenteritis (PRGE) is responsible for high morbidity, particularly among children under 3 years of age attending day care centers (DCCs). The objectives of this study were to estimate the incidence, management and cost of PRGE in DCCs. We also described the nature of group A rotavirus genotypes. This study also compared the performance of different diagnostic techniques. The study was conducted from November 2004 to May 2005. Children aged less than 36 months, attending a participating DCC at least 4 times a week were included in the study. For any episode of acute gastroenteritis (AGE), defined as the occurrence of 3 or more watery or looser than normal stools and/or forceful vomiting within a 24 h period, a fecal specimen was tested by Elisa test IDEIA Rotavirus (Dako) and the immunochromatographic test VIKIA Rota-Adeno (BioMérieux). Sequencing by RT-PCR was performed to identify the rotavirus genotype. Among the 41 DCCs contacted, 18 (43.9%) agreed to participate. Out of 966 children, 547 attended a participating DCC at least 4 times a week and met the inclusion criteria. A total of 302 were included in the study. The clinical diagnosis of AGE was confirmed and validated, by the Elisa test, in 63 fecal specimens, of which 29 (46%) were positive for rotavirus antigen, with a predominance of P[8]G9 (86%). Our results showed good sensitivity and specificity for the VIKIA and Elisa methods when compared to RT-PCR. Among the PRGE cases, 36% were male and the median age was 12.2 months. The first rotavirus case was observed in December 2004 with a peak in January 2005. The incidence of PRGE cases was 2.2 [1.4-3.0] per 100 child-months in children aged less than 36 months of age, increasing to 3.4 per 100 child-months among children aged less than 24 months. Vomiting (P<0.0005) and behavior modification (P<0.001) were significantly more frequent for PRGE cases. A total of 85.7% PRGE cases sought medical attention. In 58.3% of these cases, at least one parent had to miss work for a mean duration of 2.1 days. The total cost of rotavirus cases seeking medical attention (with or without prescribed medication, days off work for parents or additional diaper consumption) was estimated at 275.54 euros/case. The PRGE incidence rate is similar to that estimated in European studies conducted in DDC. These findings confirm that rotavirus transmission occurs not only in DCCs but within the family. This is the first study to give an estimate of the incidence and the cost of rotavirus infection in DCCs in France.

[Evolution of influenza vaccination coverage in France from 2001 to 2006]. / Evolution du taux de couverture vaccinale contre la grippe en France : de 2001 à 2006.

INTRODUCTION: The increased risk of a new influenza pandemic has raised awareness of the need for high influenza vaccination rates. OBJECTIVES: This study aims at assessing trends in influenza vaccination coverage from 2001 to 2006 in France, at understanding the drivers and barriers, and to identify vaccination intentions for 2006/2007. METHODS: We conducted a mail-based household survey on 9,835 persons representative of the population from age 15. Essentially, the same questionnaire was used in all seasons. RESULTS: The influenza vaccination coverage rate slightly increased, reaching 24.2% in 2005/2006 (70.1% in patients over 65). In the last two seasons the fact that the vaccination was provided for free was the most frequent reason for getting vaccinated. Older age, considering influenza as a serious disease and recommendations from the family doctor or nurse were also important drivers for vaccination. Only 2% of those vaccinated in 2005/2006 indicated the threat of avian influenza as a reason. The reasons for non-vaccination among persons never vaccinated before were feeling too young for vaccination, never having considered vaccination before and absence of recommendation by the family doctor. Among those who were previously vaccinated but not in the current season, the reasons for not being vaccinated were not finding vaccination necessary, forgetfulness and having influenza-like illness despite vaccination. CONCLUSION: Stable vaccination rates were observed from 2001 to 2006. France is well on its way to reach the international vaccination goal set by the WHO (75% in the elderly population), but continuously effort is needed for others.

Seroprevalence of varicella antibodies among pregnant women in Lyon-France.

The purpose of the study was to calculate the seroprevalence of immunity to the varicella-zoster virus (VZV) infection and to evaluate the positive predictive value (PPV) and the negative predictive value (NPV) of the self-reported history of VZV infection in pregnant women. A cross sectional study was conducted in 18 private medical analysis laboratories. Information on socio-demographic characteristics and past history of varicella or zoster were collected using a questionnaire. Blood samples were obtained to determine the serological levels of past exposure to VZV. Overall, 486 pregnant women were recruited. The seroprevalence of VZV antibodies was 98.8%. Six women were seronegative, of whom four were primiparous. The PPV was high (99.5%) while the NPV was only 10.3%. The PPV is a reliable marker of prior VZV infection. In contrast, a negative history does not predict lack of immunity and should be completed by serological analysis which might be introduced to routine antenatal blood tests.

Preliminary safety assessment of an arachidonic acid-enriched oil derived from Mortierella alpina: summary of toxicological data.

An arachidonic acid-enriched oil (AA-oil), derived from Mortierella alpina was subjected to a programme of studies to establish its preliminary safety for use in infant nutrition. This was addressed at two levels: (1) HPLC analysis of metabolites produced by the production strains at various conditions, and (2) an evaluation of the toxicity of the final product. The following studies were carried out on the AA-oil: gene mutation assays in bacteria and mammalian cells in vitro; chromosome aberration assays both in vitro and in vivo and acute and subacute (4-wk) oral toxicity in the rat. No known mycotoxins were produced by the production strains under the conditions tested. Further, the oil did not show mutagenic or clastogenic activity and the acute oral toxicity, expressed as the LD50 value, exceeded 20 ml/kg body weight, that is, 18.2 g/kg body weight. In the subacute oral toxicity study the AA-oil was tested as such and in combination with a docosahexaenoic-enriched oil (DHA-oil) derived from fish oil at a ratio of 2:1 (AA:DHA). This was done because high dose levels of AA may result in adverse effects; DHA can compensate for these effects. Furthermore, human milk contains both AA and DHA at a ratio of AA:DHA of 2 to 3:1. No obvious signs of toxicity were observed. Levels of phospholipids and triglycerides tended to be decreased in the highest dose groups. The no-observed-adverse-effect level of the AA-oil in the subacute 4-wk toxicity study was placed at the highest levels tested, namely 3000 mg AA-oil/kg body weight/day as such and in the combination of 3000 mg AA-oil and 1500 mg DHA-oil/kg body weight/day. This corresponds to an intake of 1000 mg AA/kg body weight/day, which represents approximately 37 times the infant intake of AA in human milk.